Abstract
Information must be collected, evaluated and utilized to support every qualified activity. Medicine, with a written scientific tradition stretching back more than 2,000 years, is no exception. Here, we discuss a number of important items associated with the establishment of a drug information centre run by clinical pharmacologists and information pharmacists, serving a broad demand, mainly among clinical specialists. The working methods include a professional literature search, critical evaluation of the material, writing a structured answer, quality control, feedback to the inquirer and storage in a database which is publicly available. One can foresee even more complex systems wherein a number of active and specialized databases communicate to provide relevant advice and support at the point of care, supplying information on drug recommendations, reimbursement, environmental aspects, antimicrobial resistance, pharmacogenetics and adverse effects, and linked to a list of prescribed drugs for the individual patient. This will be possible in both rich and poor countries through the application of modern and developing information technology. However, research on the best and safest methods of such decision support systems will be needed to ensure that they really do improve the quality of drug prescribing and use.
References
Orme M, Sjöqvist F, Birkett D, Rägo L, Sjölin-Forsberg G. (Eds) Abernethy D, Birkett D, Brosen K, Cascorbi I, Gustafsson LL, Hoppu K, Maxwell S, Orme M, Rago L, Rawlins M, Reidenberg M, Sjoqvist F, Smith T, Thuerman P, Walubo A (2012) Clinical pharmacology in health care, teaching and research. Geneva, WHO, CIOMS, IUPHAR (International Union of Pharmacology and Clinical Pharmacology). Available at: http://www.who.int/medicines/areas/quality_safety/safety_efficacy/who_cioms2012/en/. Accessed 5 Feb 2013
Bergman U, Wiholm BE (1981) Drug-related problems causing admission to a medical clinic. Eur J Clin Pharmacol 20:193–200
Gautam K (2008) Addressing the research-practice gap in healthcare management. J Public Health Manag Pract 14:155–159
Grol R, Grimshaw J (2003) From best evidence to best practice: effective implementation of change in patients’ care. Lancet 362:1225–1230
Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, Farrar K, Park BK, Breckenridge AM (2004) Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 329:15–19
Tumwikirize WA, Ogwal-Okeng JW, Vernby A, Anokbonggo WW, Gustafsson LL, Lundborg CS (2007) Access to up-to-date drug information in developing countries continues to pose problems: the case of Uganda. Pharmacoepidemiol Drug Saf 16:1177–1179
Godman B, Wettermark B, Hoffmann M, Andersson K, Haycox A, Gustafsson LL (2009) Multifaceted national and regional drug reforms and initiatives in ambulatory care in Sweden: global relevance. Expert Rev Pharmacoecon Outcomes Res 9:65–83
Gustafsson LL, Wettermark B, Godman B, Andersen-Karlsson E, Bergman U, Hasselstrom J, Hensjo LO, Hjemdahl P, Jagre I, Julander M, Ringertz B, Schmidt D, Sjoberg S, Sjoqvist F, Stiller CO, Tornqvist E, Tryselius R, Vitols S, von Bahr C (2011) The ’wise list’—a comprehensive concept to select, communicate and achieve adherence to recommendations of essential drugs in ambulatory care in Stockholm. Basic Clin Pharmacol Toxicol 108:224–233
Alvan G, Ohman B, Sjoqvist F (1983) Problem-oriented drug information: a clinical pharmacological service. Lancet 2:1410–1412
Griffey RT, Lo HG, Burdick E, Keohane C, Bates DW (2012) Guided medication dosing for elderly emergency patients using real-time, computerized decision support. J Am Med Inform Assoc 19:86–93
Davies EC, Green CF, Taylor S, Williamson PR, Mottram DR, Pirmohamed M (2009) Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes. PLoS One 4:e4439
Lyrvall H, Nordin C, Jonsson E, Alvan G, Öhman B (1993) Potential savings of consulting a drug information center. Ann Pharmacother 27:1540
Elwin CE, Falkenberg G, Larsson S (1975) A new dimension in drug information sources available to Swedish physicians. Drug Inf J 9:80
Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312:71–72
Taubes G (1996) Looking for the evidence in medicine. Science 272:22–24
Öhman B, Lyrvall H, Tornqvist E, Alvan G, Sjoqvist F (1992) Clinical pharmacology and the provision of drug information. Eur J Clin Pharmacol 42:563–567
Öhman B (1992) The development and use of a clinical drug information system. PhD thesis. Department of Clinical Pharmacology, Karolinska Institutet, Stockholm
Nörby U, Kallen K, Eiermann B, Korkmaz S, Winbladh B, Gustafsson LL (2012) Drugs and birth defects: a knowledge database providing risk assessments based on national health registers. Eur J Clin Pharmacol. doi: 10.1007/s00228-012-1399-y
Andersson ML, Bottiger Y, Lindh JD, Wettermark B, Eiermann B (2013) Impact of the drug-drug interaction database SFINX on prevalence of potentially serious drug-drug interactions in primary health care. Eur J Clin Pharmacol 69:565–571
Kimland Eyfells E (2010) Drug treatment in children with focus on off-label drug use. PhD thesis. Department of Clinical Pharmacology, Karolinska Institutet, Stockholm
Bottiger Y, Laine K, Andersson ML, Korhonen T, Molin B, Ovesjo ML, Tirkkonen T, Rane A, Gustafsson LL, Eiermann B (2009) SFINX-a drug-drug interaction database designed for clinical decision support systems. Eur J Clin Pharmacol 65:627–633
Sjoqvist F, Bergman U, Dahl ML, Gustafsson LL, Hensjo LO (2002) Drug and therapeutics committees: a Swedish experience. WHO Drug Information 16:207–213
Bates DW, Gawande AA (2003) Improving safety with information technology. N Engl J Med 348:2526–2534
Eiermann B, Bastholm-Rahmner P, Korkmaz S, Lilja B, Shemeikka T, Veg A, Wettermark B, Gustafsson LL (2010) Knowledge databases for clinical decision support in drug prescribing—development, quality assurance, management, integration, implementation and evaluation of clinical value. In: Jao CS (ed) Clinical decision support. INTECH, Croatia
Eliasson M, Bastholm P, Forsberg P, Henriksson K, Jacobson L, Nilsson A, Gustafsson LL (2006) Janus computerised prescribing system provides pharmacological knowledge at point of care—design, development and proof of concept. Eur J Clin Pharmacol 62:251–258
Bergk V, Haefeli WE, Gasse C, Brenner H, Martin-Facklam M (2005) Information deficits in the summary of product characteristics preclude an optimal management of drug interactions: a comparison with evidence from the literature. Eur J Clin Pharmacol 61:327–335
Cars T, Wettermark B, Malmstrom RE, Ekeving G, Vikstrom B, Bergman U, Neovius M, Ringertz B, Gustafsson LL (2013) Extraction of electronic health record data in a university hospital: comparison of automatic and semi-automatic methods using anti-TNF-alpha drug therapy as model. Basic Clin Pharmacol Toxicol. doi: 10.1111/bcpt.12055
Haerian K, Varn D, Vaidya S, Ena L, Chase HS, Friedman C (2012) Detection of pharmacovigilance-related adverse events using electronic health records and automated methods. Clin Pharmacol Ther 92:228–234
Maxwell S, Eichler HG, Bucsics A, Haefeli WE, Gustafsson LL (2012) e-SPC - delivering drug information in the 21st century: developing new approaches to deliver drug information to prescribers. Br J Clin Pharmacol 73:12–15
Swedish Information for Drug Informatics (SIDI) (2012) Information about DRUGLE. SIDI homepage. www.sidi.se. Accessed 11 Oct 2012
Menon-Andersen D, Yu B, Madabushi R, Bhattaram V, Hao W, Uppoor RS, Mehta M, Lesko L, Temple R, Stockbridge N, Laughren T, Gobburu JV (2011) Essential pharmacokinetic information for drug dosage decisions: a concise visual presentation in the drug label. Clin Pharmacol Ther 90:471–474
Kendall M, Enright D (2012) Provision of medicines information: the example of the British National Formulary. Br J Clin Pharmacol 73:934–938
Hicks JK, Crews KR, Hoffman JM, Kornegay NM, Wilkinson MR, Lorier R, Stoddard A, Yang W, Smith C, Fernandez CA, Cross SJ, Haidar C, Baker DK, Howard SC, Evans WE, Broeckel U, Relling MV (2012) A clinician-driven automated system for integration of pharmacogenetic interpretations into an electronic medical record. Clin Pharmacol Ther 92:563–566
Sjoborg B, Backstrom T, Arvidsson LB, Andersen-Karlsson E, Blomberg LB, Eiermann B, Eliasson M, Henriksson K, Jacobsson L, Jacobsson U, Julander M, Kaiser PO, Landberg C, Larsson J, Molin B, Gustafsson LL (2007) Design and implementation of a point-of-care computerized system for drug therapy in Stockholm metropolitan health region—Bridging the gap between knowledge and practice. Int J Med Inform 76:497–506
Gustafsson LL (2012) Medical and academic leadership is required for IT support for drugs. The principles of good decision support practice (GDSP) should be followed. Lakartidningen 109:1398–1399
Alvan G, Edlund C, Heddini A (2011) The global need for effective antibiotics-a summary of plenary presentations. Drug Resist Updat 14:70–76
Sadasivam RS, Gathibandhe V, Tanik MM, Willig JH (2012) Development of a point-of-care HIV/AIDS medication dosing support system using the Android mobile platform. J Med Syst 36:1583–1591
Acknowledgements
The work presented here has been possible due to the expertise and commitments of several colleagues over the years at the Department of Clinical Pharmacology, Karolinska University Hospital, Karolinska Institutet, at several Departments of Clinical Pharmacology in Sweden, Denmark and Finland and at the former Department of Drug Management and Informatics and the Janus project at Stockholm Healthcare Region. The concept with electronic SPCs was initiated by European Medicines Agency (EMA) and colleagues across academic and healthcare institutions in Europe. The Internet accessible Drugline has been developed in collaboration with SIDI (Swedish Institute for Drug Informatics) and its Technical Executive Officer Daniel Rodriguez. The Drugline project has been funded by SE (The Internet Infrastructure Foundation).
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Alván, G., Andersson, M.L., Asplund, A.B. et al. The continuing challenge of providing drug information services to diminish the knowledge—practice gap in medical practice. Eur J Clin Pharmacol 69 (Suppl 1), 65–72 (2013). https://doi.org/10.1007/s00228-013-1484-x
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DOI: https://doi.org/10.1007/s00228-013-1484-x